Journal of Interpersonal

Violence
Volume 21 Number 9
September 2006 1156-1168
Women’s Response to © 2006 Sage Publications
10.1177/0886260506290421
Intimate Partner Violence http://jiv.sagepub.com
hosted at
http://online.sagepub.com
Isabel Ruiz-Pérez
Andalusian School of Public Health, Granada, Spain
Nelva Mata-Pariente
Institute of Public Health, Health Council, Madrid, Spain
Juncal Plazaola-Castaño
Andalusian School of Public Health, Granada, Spain

The responses of women to a situation of abuse by their partner has hardly

been addressed in the literature. Using a self-administered, anonymous ques-
tionnaire, 400 women attending three practices in a primary health care
center in Granada (Spain) were studied. The women’s response to abuse was
used as a dependent variable. Sociodemographics, intensity, duration, and
combination of the types of abuse were used as independent variables.
Lifetime prevalence of any type of partner abuse was 22.8%. Of abused
women, 68% showed an active response, attempting to resolve the situation
mainly through separation (58.2%). The factors independently associated
with a woman’s active response were being separated, widowed, or divorced;
reporting a greater intensity of abuse; and being younger than age 35 years.
The results of this study show that a large majority of abused women in Spain
try to resolve their situation, and that they are not passive victims.

Keywords: domestic violence; spouse abuse; women; attitude

I ntimate partner violence (IPV) is one of the acts included in the category
of violence against women or gender-based violence. This type of vio-
lence evolves from patriarchal social structures that imply women’s subor-
dinate status in society (Heise, Ellsberg, & Gottemoeller, 1999). IPV is
defined as physical, sexual, and psychological violence, perpetrated by the
man who is or was the woman’s intimate partner. This is one of the least
visible types of violence, as it takes place within the family home (Krug,
Mercy, Dahlberg, & Zwi, 2002).

Authors’ Note: Please direct correspondence concerning this article to Isabel Ruiz Pérez,
Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Apartado de Correos
2070, E-18080 Granada, Spain; e-mail: isabel.ruiz.easp@juntadeandalucia.es

1156

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 Ruiz-Pérez et al. / Women’s Response to IPV 1157

Although physical violence is the most visible form of IPV, it is impor-

tant to notice that there are other types of violence (psychological and
sexual) that in the long term can have as much, if not more, of an impact on
women’s health (Campbell et al., 2002; Coker, Smith, McKeown, & King,
2000; Pico-Alfonso, García-Linares, Celda-Navarro, Herbert, & Martínez,
2004; Romito, Molzan, & De Marchi, 2005).
In terms of IPV prevalence, the figures range from 10% to 69%, depend-
ing on the scope of the study, the year, and the country where it is con-
ducted (Anonymous, 2000; Geary & Wintage, 1999; Heise et al., 1999;
Melnick, Maio, & Blow, 2002; Zachary, Mulvihill, & Burton, 2001). In
Spain, a Macro-Survey carried out by the Women’s Institute in 1999 found
that 12.4% of women were technically considered to have been abused by
their partner (Women’s Institute, 1999). In a second survey, carried out in
2002, frequency was 11.1% (Women’s Institute, 2002). Medina-Ariza and
Barberet (2003) found, in a population-based study, that 45.5% of the
women studied were victims of psychological abuse, 8% of physical abuse,
and 11.4% of sexual abuse. Another study found that 31.5% of women
attending a primary health care center presented lifetime IPV of any type
(Raya Ortega et al., 2004). It is worth noting that the magnitude of the
problem in the country is such that the government has recently enacted an
Integrated Law Against Domestic Violence, to urge social, legal, and health
services to work together in the eradication of IPV.
An aspect that has received little attention in the literature is that of the
responses of women to a situation of IPV. The question that often arises is:
Why do women stay in an abusive relationship? For some authors, to ask
this question is to place the responsibility on the abused women, and also
to assume that a high percentage of abused women do not abandon a rela-
tionship of this type (Medina, 2002).
From a psychological angle, attempts have been made to explain why
women remain in an abusive relationship (the woman’s masochistic nature
and emotional dependence); however, more often and from a more socio-
logical perspective, emphasis is placed on the fear of retaliation, the fear of
losing their children, the financial dependence, the lack of support from
friends and family, and the constant hope that “he might change” (Ellsberg,
Peña, Herrera, Liljestrand, & Winkvist, 2000). At the same time, denial of
the situation and fear of social rejection very often prevent women from
seeking help. In developing countries, women talk of being single or unmar-
ried as something social and culturally unacceptable, and this fact consti-
tutes an additional obstacle that keeps them from leaving an abusive
relationship.

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1158 Journal of Interpersonal Violence

However, various qualitative studies have shown that the majority of abused
women are not passive victims but, on the contrary, tend to adopt strategies to
guarantee their safety and that of their children by assessing the risk or danger
inherent in their situation (Krug et al., 2002). In Nicaragua, 41% of women
stated they had separated from their partner, either permanently or temporarily
(Ellsberg, Winkvist, Peña, & Stenlund, 2001). It should be considered that sep-
aration and disclosing the violence are not the only active responses women can
adopt in their situation. In a study carried out in South Carolina, 87.3% of
women experiencing IPV disclosed their abusive relationship and shared their
feelings with family, friends, doctors, or therapists (Coker & Derrick, 2000).
Furthermore, a woman’s response to a situation of IPV will be conditioned
by the circumstances of the abuse and the options available to her. As far back
as 1988, Strube (1988) showed that the factors contributing to women not aban-
doning the relationship were the lack of financial resources, a not very severe
abusive relationship, and a situation that does not directly affect the children.
It is also important to remark that the options available to a woman are
conditioned by factors beyond her control, such as the attitude of the com-
munity toward IPV, the resources available for abused women, and access
to financial resources and social support (Ellsberg et al., 2001). In this
sense, when a woman decides to seek help, the response she receives from
the community determines her future actions.
The aim of the current study is to identify and analyze the responses to
IPV adopted by abused Spanish women. The current study forms part of a
broader research project on IPV (Mata & Ruiz, 2002).

Method

Participants and Setting

A cross-sectional survey was carried out in three practices of a primary
health care center in Granada, Spain. All women ages 18 to 65 years attend-
ing these practices for whatever reason during July 2002 were included in
the study. Following the Ethical and Safety Recommendations for Research
on Domestic Violence against Women (World Health Organization [WHO],
1999), females accompanied by their male partners were excluded from the
study. Women who could not understand Spanish and those with severe
cognitive disabilities were also excluded.
Accepting an alpha risk of .05 for an accuracy of ± .05 in a bilateral
contrast for an estimated proportion of .5, a random population sample of
385 participants was defined.

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 Ruiz-Pérez et al. / Women’s Response to IPV 1159

Survey Measures and Instrument

The outcome measure was women’s response to IPV, that included:
none, reporting the abuse to the authorities, partner separation, seeking help
from battered women’s associations, and seeking help from health care pro-
fessionals. These categories were not mutually exclusive. For analysis pur-
poses, this measure was divided into two categories: active response (if the
participant responded affirmatively to at least one of the options) and pas-
sive response (when the participant answered negatively to all the options).
The independent variables considered in this study were:

• Sociodemographics: age, number of children, marital status, employment

status, education, and monthly family income
• Variables related to IPV: intensity of IPV and combination of the types of
lifetime abuse (physical, psychological, and sexual); duration of the abuse
(< 1 year, 1 to 5 years and > 5 years).

A self-administered structured questionnaire was specifically designed for

the current study. It included 14 closed-ended questions that could be answered
in 10 minutes. Six of the questions referred to sociodemographic variables. Six
inquired about the intensity and type of IPV (in a current and a previous rela-
tionship). Each of these six questions had three possible responses reflecting
intensity: very often, sometimes, and never (i.e., Have you ever been abused by
your current partner physically [hit, slapped, kicked, pushed]? And what about
a previous partner?). The woman was considered “abused” if she replied very
often or sometimes to any of the six abuse-related questions. The woman was
considered to have ever experienced physical IPV if she answered very often
or sometimes to any of the two specific questions about physical IPV (with a
current or previous partner), and the same applied to psychological and sexual
abuse. Given that there is usually considerable overlap between IPV types, we
created combinations of abuse: one type of abuse, two types of abuse, and three
types of abuse for analysis purposes. One question asked about the duration of
abuse, and in a final question women were asked about their response to IPV
(in case of abuse). The formulation of the questions was based on scales used
in other studies, such as the WHO Multi-Country Study on Women’s Health
and Life Events (Straus, 1990; WHO, 2003).

Procedure
The information was gathered by a trained researcher in the waiting
room of the three primary health care practices. Having asked the woman
for her collaboration and having checked whether she met the inclusion

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1160 Journal of Interpersonal Violence

criteria, a brief introduction was given to her explaining that a study on

health and women was being conducted. If the woman gave consent for par-
ticipation, she was handed the questionnaire in a sealed envelope. Particular
emphasis was placed on the confidentiality and anonymity of the responses,
and on the importance of answering all the questions. The researcher
offered to help women fill in the questionnaire if necessary. When com-
pleted, the woman deposited the questionnaire in a box prepared for this
purpose. The envelope containing the questionnaire also included informa-
tion on available community resources for battered women in the area.

Data Analysis
An initial descriptive analysis was carried out using number of cases and
percentages for qualitative variables. The association between the depen-
dent variable and each of the independent variables was analyzed using the
chi-squared test. Statistical significance was set at p < .05. The magnitude
of the association was estimated using the odds ratio (OR), with a
Confidence Interval (CI) of 95%. Finally, a logistic regression analysis was
conducted for the joined control of possible confounding factors. Included
in the model were all the significant variables in the bivariate analysis and
all those considered to be of interest for the current study. It should be noted
that some of the variables were recoded for the bivariate and multivariate
analysis, given the small number of women in some of the initial categories
of the variables used in the descriptive analysis.

Results

During the period of the current study, the three practices were attended
by 853 women. Of all these, 449 met inclusion criteria, and 49 refused to
participate (36 of these claimed they were in a hurry). Therefore, 400
women completed the questionnaire (response rate of 89.08%).
Table 1 shows the sociodemographic characteristics of the sample and
IPV-related characteristics. The most frequent age group was 36 to 50 years
(40.3%), and 34% of the sample had two children. Of the women, 68%
were married, and 45.3% were employed. The majority of the women
(47.9%) had only primary studies or no studies at all, and 55.2% reported a
monthly family income between 600 and 1,200 euros.
The prevalence of any type of lifetime IPV was 22.8% (n = 91). Among
abused women, it was observed that 53.8% experienced only one kind of
abuse, 29.7% two types, and 16.5% all three types. Regarding abuse duration,

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 Ruiz-Pérez et al. / Women’s Response to IPV 1161

Table 1
Sociodemographic and Intimate Partner Violence (IPV)–Related
Characteristics of the Sample (N = 400)
Variables na %

Age
18 to 35 years 137 34.9
36 to 50 years 158 40.3
51 to 65 years 97 24.8
Number of children
None 96 24.0
1 child 56 14.0
2 children 136 34.0
3 to 7 children 112 28.0
Marital status
Married 272 68.0
Single 82 20.5
Separated and/or divorced 29 7.3
Widowed 17 4.2
Employment status
Housewife 159 39.8
Employed 181 45.3
Student 23 5.9
Unemployed 36 9.0
Education
None or primary 190 47.9
Secondary 104 26.2
Further and/or university 103 25.9
Monthly family income
< 600 Euros 67 18.3
600 to 1200 Euros 202 55.2
> 1200 Euros 97 26.5
Intensity of IPV
Very often 36 9.0
Sometimes 55 13.8
Never 309 77.2
Combination of the types of abuse
One type of abuse 49 53.8
Two types of abuse 27 29.7
Three types of abuse 15 16.5
Duration of abuse
1 month to 1 year 24 31.6
1 to 5 years 19 25.0
> 5 years 33 43.4

a. Total sample numbers differ because of missing data.

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1162 Journal of Interpersonal Violence

Table 2
Response to Intimate Partner Violence (IPV)
Adopted by Abused Women (n = 91)
Response N %

Active response to IPV (the woman does something) 54 68.4

Partner separation 46 58.2
Report of IPV to the authorities 12 15.2
Seeking help from healthcare professionals 12 15.2
Seeking help from battered women’s associations 5 6.3

43.4% of the abused women stated they had been victims of abuse for more
than 5 years.
In terms of the response to IPV adopted by abused women, 68.4%
showed an active response, attempting to resolve the situation mainly
through separation (58.2%), followed by reporting the abuse to the author-
ities (15.2%), seeking help from health professionals (15.2%), and seeking
help from battered women’s associations (6.3%; see Table 2).
The association of the sociodemographic and IPV-related variables with
the woman’s response to IPV is shown in Table 3. As age increases, the fre-
quency of abused women trying to resolve this situation drops (84.6% of
those ages younger than 35 years, compared to 54.5% of those ages more
than 50 years; OR = .21, 95% CI = .05-.84). Regarding marital status,
abused women who were single and those who were separated, divorced,
and widowed were more likely to have an active response to IPV than
married abused women (OR = 7.36; 95% CI = 1.47-36.83, and OR = 7.36,
95% CI = 1.88-28.79, respectively). Similarly, employed, students, and
unemployed abused women were more likely to have an active response to
IPV than housewives (OR = 3.56, 95% CI = 1.32-9.59). The probability of
an active response to IPV decreased with an increase of number of children
and monthly family income and with a decrease of educational level,
although these differences were not statistically significant.
Regarding IPV characteristics, women reporting a greater abuse inten-
sity (“very often”) had a more active response to IPV than women with a
lower abuse intensity (“sometimes”; OR = 3.95, 95% CI = 1.36-11.46).
Women who referred having experienced two and three types of abuse
simultaneously also had a more active response to IPV than those that expe-
rienced only one kind (mostly psychological), and the probability of an

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 Ruiz-Pérez et al. / Women’s Response to IPV 1163

Table 3
Association Between Sociodemographic Variables, Variables
Related to Intimate Partner Violence (IPV) and Woman’s
Response to Reported IPV (n = 91)
Active response to IPV

95% Confidence
Na % Odds Ratiob Interval

Age
18 to 35 years 22 84.6 1 1
36 to 50 years 20 64.5 .33 .09-1.20
51 to 65 years 12 54.5 .21 .05-.84
Number of children
None 16 80.0 1 1
1 to 2 children 19 67.9 .52 .13-2.04
3 to 7 children 19 61.3 .39 .10-1.47
Marital status
Married 19 48.7 1 1
Single 14 87.5 7.36 1.47-36.83
Separated, widowed, 21 87.5 7.36 1.88-28.79
or divorced
Employment status
Housewife 16 51.6 1 1
Employed, student, 38 79.2 3.56 1.32-9.59
unemployed
Education
None or primary 24 64.9 1 1
Secondary/further/university 29 70.7 1.30 .50-3.39
Monthly family income
< 600 Euros 18 75.0 1 1
600 to >1200 Euros 30 62.5 .55 .18-1.65
Intensity of IPV
Sometimes 24 55.6 1 1
Very often 30 83.3 3.95 1.36-11.46
Combination of the types of abuse
One type of abuse 21 55.3 1 1
Two types of abuse 21 80.8 3.40 .94-12.96
Three types of abuse 12 80.0 3.24 .68-17.35
Duration of abuse
1 month to 1 year 5 78.3 1 1
1 to 5 years 6 66.7 .55 .13-2.23
> 5 years 2 63.6 .48 .14-1.64

a. Total sample numbers differ because of missing data.

b. The comparison group comprised those abused women who reported no active response to
IPV (n = 37).

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1164 Journal of Interpersonal Violence

Table 4
Factors Independently Associated With the Woman’s
Response to Intimate Partner Violence (IPV).
Logistic Regression Analysis (n = 91)
Active Response to IPV

Adjusted Odds Ratioa 95% Confidence Interval p Values

Age
18 to 35 years 1 1
36 to 50 years .20 .03-1.24 .05
51 to 65 years .18 .02-.86 .04
Intensity of abuse
Sometimes 1 1
Very often 5.88 1.59-21.65 .01
Marital status
Married 1 1
Single 5.23 .87-33.11 .07
Separated, widowed 10.41 2.26-47.91 < .01
or divorced

a. The comparison group comprised those abused women who reported no active response to
IPV (n = 37).

active response to IPV decreased with an increase of duration of abuse,

although these differences were not statistically significant.
Finally, the variables independently associated with the woman’s active
response to IPV were being separated, widowed, or divorced; referring a
greater intensity of abuse and being younger than age 35 years (Table 4).

Discussion

To our knowledge, this is one of the first studies to be published in Spain

on the response of women to IPV.
The overall prevalence of lifetime IPV of any type (physical, psycho-
logical, and/or sexual) in the current study was 22.8%. This figure is con-
sistent with data found in other international studies. In a Population Report
carried out by the Center for Health and Gender Equity (Heise et al., 1999)
that reviewed around 50 population-based studies up to 1999, between 10%
and 69% of women all over the world reported having been victims of
physical IPV at some point in their life. In European countries, the figures
ranged from 18% to 58% (Heise et al., 1999).

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 Ruiz-Pérez et al. / Women’s Response to IPV 1165

Many studies have been carried out within the health care setting (primary
or specialized health care, emergency services, or gynecology practices),
because it has been demonstrated that abused women make a greater use of
the health care system than nonabused women (Koss, Koss, & Woodruff,
1991). Internationally, and particularly in Anglo-Saxon countries (United
States, United Kingdom, and Canada), prevalence data in the health care set-
ting range between 20% and 55% (Armstrong, 2001; Bradley, Smith, Long,
& O’Dowd, 2002; Hegarty, Gunn, Chondros, & Small, 2004; Richardson
et al., 2002). It should be noted that Spain has a public National Health
System that aims to provide universal medical care. Therefore, although
prevalence data found in the current study cannot by any means be gener-
alized to the Spanish population, we should acknowledge that findings from
studies in the general practice are probably the closest data we can have to
the real magnitude of the problem.
With regard to women’s response to IPV, 68.4% of abused women in the
current study tried to resolve their situation and were, mainly, young women
and separated or single. The literature shows that the frequency of women
who experience physical violence and seek help varies between 32% in
Bangladesh, 53% in Egypt, and 78% in Canada (Heise et al., 1999).
In the current study, more than one half of the abused women opted for
separation, contradicting the traditionally held view of passiveness of
abused women. This result indicates that individual efforts are made by a
large number of women, who choose an option that very often involves a
very difficult period of cohabitation, when the most severe forms of abuse
often happen, sometimes resulting in the woman’s death.
A total of 15% of abused women in the current sample tried to resolve
their situation by reporting the abuse to the authorities. This figure may
suggest an increase in the number of reports of abuse because data from the
Spanish Ministry of Internal Affairs indicate that in 1997 only 5% of abused
women reported it (“Violencia Domestica. La Respuesta Politica,” 2002).
Until very recently, reporting and disclosing an abusive relationship and
seeking help in general has been socially repressed because IPV was con-
sidered a phenomenon limited to the private sphere. In recent years, fortu-
nately, women have been encouraged to report cases of IPV. However, this
new situation requires legal, social, and economic instruments to provide
suitable protection for the victims (Rodriguez, Sheldon, & Rao, 2002).
It is worth noting that only 6% of the women that experienced IPV
sought help in associations for battered women. The reasons for this were
not explored in the current study; however, it might be either that the
woman is not aware of the existence and availability of these resources or

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1166 Journal of Interpersonal Violence

that she does not trust their effectiveness. It would be desirable for these
organizations to work harder in making their existence well known by
means of increased publicity in the mass media.
Finally, 15% of abused women shared their problem with health care
professionals, taking the initiative and placing the doctor in a situation of
particular responsibility in such an important issue, in which prevention and
early detection are of vital importance to avoid later consequences and
greater harm.
Some studies have suggested that there are a number of factors that lead
women to end an abusive relationship. In the current study, age and inten-
sity of abuse were found to be clearly associated with attempting to resolve
an abusive situation. This result is consistent with works published in other
countries (McFarlane, Soeken, Reel, Parker, & Silva, 1997; Strube, 1988).
Ellsberg et al. (2001) found that the severity of violence seems to have an
effect on permanent separation, through its effect on the intervening coping
strategies, such as help seeking and temporary separations. It is encourag-
ing that younger women, on the whole, and compared to women of their
mothers’ generation, seem to be less tolerant of partner violence and more
willing to initially try a variety of options to end with the violence, such as
temporary separations or seeking help outside. This difference is probably
reflecting the changes in cultural attitudes toward gender violence and in
the availability of resources for abused women.
Leaving an abusive relationship is a process that typically includes periods
of denial, self-blame, and enduring the situation before the woman admits that
the abuse really exists and identifies herself with other women in the same sit-
uation. This is the beginning of the break and of the recovery. The majority of
women leave their relationship and return to it several times before definitive
abandonment. It is for this reason that detecting the situation and informing of
the existing resources in the first stages of the conflict is probably more effec-
tive than acting when the situation of abuse is already strongly present.

References
Anonymous. (2000). Prevalence of intimate partner violence and injuries-Washington 1998.
Journal of the American Medical Association, 284, 559-560.
Armstrong, J. (2001). Prevalence and incidence of domestic violence in an ambulatory gynae-
cology population and associated risk factors. Obstetrics and Gynecology, 97, S54.
Bradley, F., Smith, M., Long, J., & O’Dowd, T. (2002). Reported frequency of domestic vio-
lence: Cross sectional survey of women attending general practice. British Medical Journal,
324, 271.

Downloaded from jiv.sagepub.com at FRESNO PACIFIC UNIV on December 26, 2014

 Ruiz-Pérez et al. / Women’s Response to IPV 1167

Campbell, J., Jones, A. S., Dieneman, J., Kub, J., Schollenberger, J., O´Campo, P., et al.
(2002). Intimate partner violence and physical health consequences. Archives of Internal
Medicine, 162, 1157-1163.
Coker, A. L., & Derrick, C. (2000). Help-seeking for intimate partner violence and forced sex
in South Carolina. American Journal of Preventive Medicine, 19, 316-320.
Coker, A. L., Smith, P. H., McKeown, R. E., & King, M. J. (2000). Frequency and correlates
of intimate partner violence by type: Physical, sexual, and psychological battering.
American Journal of Public Health, 90, 553-559.
Ellsberg, M., Peña, R., Herrera, A., Liljestrand, J., & Winkvist, A. (2000). Candies in hell:
Women’s experiences of violence in Nicaragua. Social Science and Medicine, 51, 1595-1610.
Ellsberg, M. C., Winkvist, A., Peña, R., & Stenlund, H. (2001). Women’s strategic responses
to violence in Nicaragua. Journal of Epidemiology and Community Health, 55, 547-555.
Geary, F. H., & Wintage, C. B., Jr. (1999). Domestic violence and physical abuse of women:
The Grady Memorial Hospital experience. American Journal of Obstetrics and Gynecology,
181, S17-S21.
Hegarty, K., Gunn, J., Chondros, P., & Small, R. (2004). Association between depression and
abuse by partners of women attending general practice: Descriptive, cross sectional survey.
British Medical Journal, 328, 621-624.
Heise, L., Ellsberg, M., & Gottemoeller, M. (1999). Ending violence against women.
Population Reports, series L, nº 11. Baltimore: Johns Hopkins University School of Public
Health, Population Information Program.
Koss, M. P., Koss, P. G., & Woodruff, W. J. (1991). Deleterious effects of criminal victimization
on women’s health and medical utilization. Archives of Internal Medicine, 151, 342-347.
Krug, E. G., Mercy, J. A., Dahlberg, L. L., & Zwi, A. B. (2002). The world report on violence
and health. Lancet, 360, 1083-1088.
Mata, N., & Ruiz, I. (2002). Detección de violencia doméstica en mujeres que acuden a un
centro de Atención Primaria. Tesina Master de Salud Pública y Gestión Sanitaria
[Detection of domestic violence in women attending a primary health care center. Thesis
of the master in public health and health administration]. Granada, Spain: Escuela
Andaluza de Salud Pública.
McFarlane, J., Soeken, K., Reel, S., Parker, B., & Silva, C. (1997). Resource use by abused
women following an intervention program: Associated severity of abuse and reports of
abuse ending. Public Health Nursing, 14, 244-250.
Medina, J. J. (2002). Violencia contra la mujer en la pareja: Investigación comparada y
situación en España [Intimate partner violence: Comparative research and situation in
Spain]. Valencia, Spain: Tiranc lo Blanc.
Medina-Ariza, J., & Barberet, R. (2003). Intimate partner violence in Spain. Findings from a
national survey. Violence Against Women, 9, 302-322.
Melnick, D., Maio, R. F., & Blow, F. (2002). Prevalence of domestic violence and associated
factors among women on a trauma service. Journal of Trauma, 53, 33-37.
Pico-Alfonso, M. A., Garcia-Linares, M. I., Celda-Navarro, N., Herbert, J., & Martinez, M.
(2004). Changes in cortisol and dehydroepiandrosterone in women victims of physical and
psychological intimate partner violence. Biological Psychiatry, 56, 233-240.
Raya Ortega, L., Ruiz Pérez, I., Plazaola Castaño, J., Brun López-Abisab, S., Rueda Lozano,
D., García de Vinuesa, L., et al. (2004). La violencia contra la mujer en la pareja como
factor asociado a una mala salud física y psíquica [Domestic violence as a factor associ-
ated to women’s health problems]. Atención Primaria, 34, 117-127.

Downloaded from jiv.sagepub.com at FRESNO PACIFIC UNIV on December 26, 2014

1168 Journal of Interpersonal Violence

Richardson, J., Coid, J., Ptruckevitch, A., Chung, W. S., Moorey, S., & Feder, G. (2002).
Identifying domestic violence: Cross sectional study in primary care. British Medical
Journal, 324, 274.
Rodriguez, M. A., Sheldon, W. R., & Rao, N. (2002). Abused patient’s attitudes about manda-
tory reporting of intimate partner abuse injuries to police. Women Health, 35, 135-147.
Romito, P., Molzan, T. J., & De Marchi, M. (2005). The impact of current and past interper-
sonal violence on women’s mental health. Social Science and Medicine, 60, 1717-1727.
Straus, M. A. (1990). Measuring intrafamily conflict and violence: The Conflict Tactics (CT)
Scales. In M. Straus & R. Gelles (Eds.), Physical violence in American families: Risk factors
and adaptation to violence in 8,145 families (pp. 29-47). New Brunswick, NJ: Transaction
Publishers.
Strube, M. (1988). The decision to leave an abusive relationship: Empirical evidence and the-
oretical issues. Psychological Bulletin, 104, 236-250.
Violencia domestica. La respuesta política [Domestic violence. The political response]. (2002,
September 4). La vanguardia Available at www.lavanguardia.es/web/20020904/31458633
.html
Women’s Institute. (1999). La violencia contra las mujeres. Resultados de la macroencuesta
[Violence against women. Results of the Macro-Survey]. Madrid, Spain: Instituto de la
Mujer y Ministerio de Trabajo y Asuntos sociales.
Women’s Institute. (2002). Estadísticas. Mujeres en cifras. Violencia. Macroencuesta “Violencia con-
tra las mujeres” [Statistics. Women’s data. Violence. Macro-survey “Violence against women”].
Retrieved May 19, 2006, from http://www.mtas.es/mujer/mujeres/cifras/tablas/W596.XLS
World Health Organization. (1999). Putting women’s safety first: Ethical and safety recom-
mendations for research on domestic violence against women. Geneva, Switzerland: World
Health Organization, Global Programme on Evidence for Health Policy.
World Health Organization. (2003). Multi-country study on women’s health and life events.
Geneva, Switzerland: World Health Organization, Department of Gender and Women’s
Health, Family and Community Health.
Zachary, M. J., Mulvihill, M. N., & Burton, W. B. (2001). Domestic abuse in the emergency
department: Can a risk profile be defined? Academic Emergency Medicine, 8, 796-803.

Isabel Ruiz-Pérez, MD, PhD, is the director of the Research Department of the Andalusian
School of Public Health (Granada, Spain). She is currently the scientific coordinator of the
Spanish Network for Research on Health and Gender (Carlos III Health Institute; G03/042).
Her research interests include gender and health and HIV/AIDS.

Nelva Mata-Pariente, MD, has just finished her residency in preventive medicine and is cur-
rently working in the Epidemiology Service of the Institute of Public Health (Madrid, Spain).
She has a master’s in public health and health management. Her research interests include Public
Health.

Juncal Plazaola-Castaño has a bachelor’s degree in psychology and is currently doing her
PhD. She works in the Andalusian School of Public Health (Granada, Spain) within the
Spanish Network for Research on Health and Gender (Carlos III Health Institute; G03/042).
Her research interests include intimate partner violence and fibromyalgia.

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